Gastroenterology Book

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Dyspepsia in Pregnancy

Aka: Dyspepsia in Pregnancy, Gastroesophageal Reflux in Pregnancy, GERD in Pregnancy
  1. See Also
    1. Dyspepsia
    2. Nausea in Pregnancy
    3. Abdominal Pain in Pregnancy
    4. Gastrointestinal Medications in Pregnancy
    5. Gastroesophageal Reflux
  2. Evaluation
    1. Avoid diagnostic testing in pregnancy
  3. Management: First Line Agents
    1. General Measures
      1. See Gastroesophageal Reflux
      2. See Gastritis
      3. Drink 8 glasses (8 ounces) non-caffeinated fluid daily
      4. Decrease provocative foods
        1. Decrease or eliminate Caffeine, chocolate, spicy foods
        2. Avoid milk products toward end of day
        3. Avoid fatty foods
      5. Tobacco Cessation
      6. No eating food 2-3 hours before bedtime
      7. Elevate head of bed to 30 degrees
    2. First: Antacids (may interfere with iron absorption)
      1. Avoid Antacids that contain Salicylates, or Sodium Bicarbonate (alka-seltzer, due to alkalosis)
      2. Aluminum hydroxide - Magnesium Hydroxide (Maalox)
      3. Calcium Carbonate (Tums)
    3. Next: Gastric mucosa protection or skip to H2 Blocker
      1. Sucralfate 1 gram orally three times daily (not effective in GERD)
    4. Next: H2 Blocking Agents (Avoid Axid or Nizatidine)
      1. Ranitidine (Zantac) 150 mg orally twice daily
        1. Preferred H2 Blocker in pregnancy
      2. Cimetidine (Tagamet) 400 mg orally twice daily or at bedtime
      3. Famotidine (Pepcid)
  4. Management: Refractory cases
    1. Metoclopramide (Reglan)
    2. Avoid Proton Pump Inhibitors (e.g. Prilosec) unless approved by a primary maternity care provider
      1. Class C Medication
      2. Unknown longterm safety (although Omeprazole is considered likely safe)
  5. References
    1. Larimore (2000) Prim Care 27(1):35-53 [PubMed]
    2. Winbery (2001) Obstet Gynecol Clin North Am 28(2):333 [PubMed]
    3. Gregory (2018) Am Fam Physician 98(9): 595-602 [PubMed]

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